From Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia (A.B., M.P.); and Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland (K.M.).

From Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia (A.B., M.P.); and Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland (K.M.).

From Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia (A.B., M.P.); and Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland (K.M.).

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In Response:

We thank Roozenbeek and colleagues for their interest in our recent work.1 The clinical significance of the ischemic penumbra in patients treated with intravenous thrombolysis is well established.2 The term mismatch has become colloquially used to describe the situation where the relative volume of a patient’s infarct core is less than the total perfusion lesion, thus representing the penumbra. Target mismatch is simply a way of defining a group of patients with a relatively large penumbra that is salvageable from infarction with effective reperfusion. In patients without such a target mismatch, there is limited brain tissue to salvage, and this translates clinically into less benefit from reperfusion.3 Therefore, …